logistics and supply systems - world health organization phemap... · logistics and supply systems...

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TRAINING COURSE ON

PUBLIC HEALTH AND EMERGENCY MANAGEMENT IN ASIA AND THE PACIFIC

LOGISTICS AND SUPPLY SYSTEMS

LOGISTICS AND SUPPLIESPHEMAP |

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Learning Objectives

By the end of this module, the participant should be able to:• Discuss the roles and responsibilities of the

health sector in developing supplies and logistics systems for emergencies

• Discuss the challenges and constraints facing the health sector in managing supplies and logistics in emergencies

• Describe the tools available to support planning and managing supplies and logistics in emergencies

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Plan of the Module

1. Logistics systems

2. Supplies management

3. Management of international relief teams

4. Logistics exercise


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1. Logistics

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References for Logistics and Supply

1. New Emergency Health Kit – can serve as a model for a national drugs and equipment list for emergencies – from WHO

2. UNHCR Tools and Resources handbook

3. WHO Reference Values handbook

4. Supply catalogues from IAPSO, UNICEF, UNHCR, MSF, Oxfam

5. WHO laboratory, sanitation, nutrition, surgical care, environmental health, communicable disease guidelines for emergencies


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Questions and Answers

• What is Logistics ?

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What is Logistics?

Logistics is a system which provides the means to acquire and deliver resources (material and human) :

1. To the RIGHT place

2. At the RIGHT time

3. In the RIGHT quantity

4. At the RIGHT quality

5. At the RIGHT price


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Damage Assessments and Logistics

At the time of an emergency, the following elements of a Damage Assessment and Needs Analysis (DANA) are relevant to planning logistics:

1. Communications systems

2. Transport systems (road, rail, air, sea)

3. Storage and Distribution systems

4. Utilities networks� Electricity / gas networks� Water supply systems� Fuel storage and distribution systems� Waste disposal systems

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The Scope of Logistics in an Emergency Response

1. Operational Planning based on Damage Assessment and Needs Analysis

2. Procurement / accepting donations system

3. Transport / fleet management system

4. Warehousing / stock control system

5. Distribution system

6. Tracking system

7. Reporting system


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Logistics Systems

Logistics

NetworksHuman

ResourcesStandards

and SystemsStocks

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Logistics Systems

Agreements (MoU) between:

• Military/ Red Cross and agencies/ departments of government

• Manufacturers/ suppliers/stockists (preferred suppliers)

MOH stock• stockpiles• buffer stocks

UN Agencies(UN warehouse in Italy)

Other organisations (Red Cross etc.)

Private/commercial sector

• pre-purchase agreements

• corporate donations

Intra- and inter-sectoral co-ordination mechanisms

Standards, guidelines, protocols, catalogues

Procedures for:- Procurement (national and international)

- Donations- Transport- Warehousing- Tracking- Reporting

Regional, National and local storage and distribution plans

Information Management Systems

Trained professional staff (1 year course)

Emergency Roster

Logistics Needs Assessment Teams

Logistics Management Unit

• Communications• Procurement• Donations• Warehousing• Transport• Finance• Reporting and tracking

Central/regional/ provincial/local government

International organisations

Private/voluntary sector

Academic/ reference institutions

National policyNational proceduresNational guidelinesNational and Local plans

StocksSystemsHuman

ResourcesNationalNetwork


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Logistics Response

Logistics Response

Field Set-up MobilisationPlan of Action

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Logistics Response

Co-ordination mechanism (intra-and inter-sectoral, international/national/local)

Procurement plan

Distribution plan

Reporting and tracking plan

Damage Assessment and Needs Analysis

Setting objectives and priorities

Operational planning

Operational Bases

Human Resources

Management Systems

MobilisationPlan of ActionField set up


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Activity

• What are the constraints associated with managing a health sector logistics systems inemergencies?

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Why are there LOGISTICS problems?

Pressure from the urgent situation and unrealistic demands/ expectations of politicians, the media and the public lead to inappropriate operational decisions because of:

1. Lack of policies and guidelines on emergency supplies

2. Lack of standards, protocols and procedures

3. Lack of coordination (national and international)

4. Lack of plans and capacity at local level to manage logistics

5. Lack of investment in professional logistics capacities and systems


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2. Supplies

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Common supplies problems …

1. Huge amounts of unrequested items arrive in the country

2. Many items are inappropriate, unnecessary, unsorted, partially used and/or loose (unpacked)

3. Items arrive without :• product information• packing lists • labels (or labels in foreign languages) and• expiry date, or already out of date

4. Items are not packed properly or protected from the environment /weather • hazardous items are not separated from others,

glass bottles are broken, food items are packed with liquids and chemicals


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Common supplies problems

5. Ports, airports and warehouses are rapidly overwhelmed with huge volumes - so items are stored outside in the open (exposed to sun, rain, humidity, wind, dust, pests, damage, fire and pilfering)

6. Items are forwarded to the affected area based on what is nearest to the truck, not on what is requested, needed or useful

7. Items arrive at the disaster area at multiple sites in an uncoordinated way and without prior notice of arrival or item lists

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Common supplies problems

8. Items arrive at the disaster area unsorted, unclassified and unrequested and in huge amounts that overwhelm capacity to distribute (so are again stored in the open)

9. Many donated items have to be destroyed and some items need special incinerators to do it

All of these problems create additional expense and management problems for the affected country


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Critical Health Sector Supplies …

There is increased demand for, AND a need to replace damage/losses, of:

1. triage, first aid and victim transport equipment (kits, tags, stretchers etc - consumables, spare parts and hardware)

2. acute care medical and surgical equipment (consumables, spare parts and hardware)

3. pharmaceuticals, vaccines, antidotes, antivenins, gases, chemicals, IV fluids, disinfectants, antiseptics

4. diagnostic / laboratory supplies (reagents, culture media)

5. blood, blood products and blood bank consumables

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Critical Health Sector Supplies …

6. personal protective equipment7. equipment and reagents for monitoring safety of food

and water8. communication, transport, administrative and

reporting needs9. food and basic cooking / household supplies (staff

and the public)10. fuel, electricity, gas and water supply systems

and equipment


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Critical Health Sector Supplies

11. orthotics, prosthetics and dental equipment12. patient care needs – beds, linen etc.13. damaged office furniture and general / administrative

supplies14. personal needs of health sector staff –

uniforms/clothing, transport, communication, accommodation, personal hygiene etc.

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Strategies for supply management capacity …

1. Develop capacity for assessment of:

a. damage to, and capacities of, critical infrastructure to maintain the continuity of the supply of goods and services

b. the supply needs of the operational agencies , gaps in meeting needs and sources/availability of supplies

2. Establish a supply management system for selecting, procuring, maintaining, storing, transporting, distributing, tracking and reporting on supplies

3. Maintain a directory of suppliers and manufacturers (including contact details, manufacturing capacity, time required for production and delivery)


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Strategies for supply management capacity

4. Establish procedures for ordering, paying for, distributing, reordering and accounting for supplies in emergencies

5. Establish a policy on donations of medical supplies and equipment

6. Participate in operational coordination and reportingmechanisms

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Components of supply management systems …

1. Standard treatment guidelines, protocols and diagnostic procedures for emergencies

2. Standard National Lists for use in emergencies:

• pharmaceuticals, vaccines, chemicals, reagents and other supplies

• kits for specific purposes (first aid, triage, injury, cholera, burns, chemical and radiation accidents etc.)

• equipment (diagnostics, laboratory, personal protective equipment, administration, assessment and administration/reporting), consumables, spare parts

3. Emergency procedures for:

• central procuring, transporting and distributing supplies

• Local ordering and replacing essential consumables by health facilities (reagents, culture media, medical supplies, pharmaceuticals, linen, food and water)

• security of controlled drugs

• reporting and accounting for supplies


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Components of supply management systems

3. Back up systems for health facilities to provide water, electricity, gases, fuel, heating/cooling, cold chains and waste-disposal

4. Regional, national, provincial and local stockpiles of essential supplies and equipment

5. Buffer stocking systems which use existing supply management systems to maintain an extra margin for emergencies (through rotating of stock - this resolves issues of safety, storage, lifetime cycle, expiry dates and packaging/ labelling)

6. Pre-agreements and MOU with manufacturers and suppliers for emergencies

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Activity

• What are the constraints associated with managing health sector supplies inemergencies?


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Why are there SUPPLIES problems?

Pressure from the urgent situation and unrealistic demands/ expectations of politicians, the media and the public lead to inappropriate operational decisions because of:

1. Lack of national policies and guidelines on emergency supplies

2. Lack of national standards, protocols and procedures

3. Lack of capacity and plans at local level to manage supplies


5. Those who accept international donations (MOFA) and process them (Customs) do not know what is actually needed

6. Lack of investment in professional logistics systems

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2a. SUMA


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Donated medicines

1976 Guatemala Earthquake

• Over 90% of donations were unsorted

• In a two-week period, 100 tons of mixed, unused medicines were delivered

1988 Armenia Earthquake

• 5,000 tons of drugs donated but only 100 tonnes was needed

• 70% of all donated drugs were inappropriate

• International aid was needed to finance the safe disposal of expired and dangerous donated medicines

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Donated medicines

1991 former Yugoslavia

1994 Rwanda

1994 WHO report on Croatia• 15% donations were completely unusable • 30% donations were not needed • 340 tonnes of expired drugs were donated - the

government spent approximately US$ 4 million to destroy them


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Donated medicines

1992-95 Bosnia and Herzegovina• 30,500 tons of drugs donated but need was only 1,800 tons• 50 to 60% of items were inappropriate

2004 Aceh Tsunami• One country donated enough medicines to supply Aceh for

one year, but there was no local capacity to store them• Donors refused to allow donated medicines to enter national

supply system and demanded all go directly to Aceh• WHO had to build a special incinerator just to destroy

dangerous and hazardous medicines/chemicals donated to Aceh – it processed an average of 20 tonnes of material a month

• PSF report on donations to Indonesia concluded that unwanted, unrequested and inappropriate donations are still a major problem in disasters

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The 2004 Tsunami

In Indonesia, the volume and variety of donated supplies and the lack of a unified supply management system linking donated and national supplies resulted in :

A logistics disaster


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SUMA

A software tool to support the management of humanitarian supplies in an emergency

It produces daily reports of all items received and distributed from a warehouse or port

It links information from multiple warehouse and port sites to produce a comprehensive accounting system for all supplies received and used in an emergency

SUMA is NOT a tracking system – it cannot follow a single item from arrival to final use

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Components of SUMA

1. Register - Every item in every shipment arriving to the country is registered by the system at the entry point

2. Classify - What is it – medicine or shelter item? Categories are fixed

3. Sort by priority

4. Inventory

5. Warehouse management

6. Follow-up pledges for donations


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SUMA Categories

• Medicines

• Food and Beverages

• Health

• Water and Environmental Health

• Personal Needs/Education

• Electrical/Construction

• Agriculture/Livestock Industry

• Human Resources

• Logistics/Management

• Shelter/Housing

• Unsorted

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Sort by Priority

Urgently Needed: Priority # 1

I wish it could dump it somewhere! # 3

Nice but can Wait: # 2


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Inventory criteria

1. Technical features

2. Presentation (syrup, tablets…)

3. Packaging (bottles, boxes...)

4. Total quantities

The greatest challenge is health supplies due to complexity and volumes of items

Customs officers and health workers must work as a team

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Graphic Overview of Suma

WAREHOUSES

DONORS

POINTS OFENTRY

FIELD UNIT CENTRAL LEVEL

Distribution

Supplies

Distributionat the point

of entry Reports

Information

Information

Information

Information

Supplies


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SUMA

1. It provides snap shots of the flow of supplies at several stages

2. It does not identify and track any single item over time: Should SUMA do that?

3. The information belongs to the host government

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SUMA in the 2004 Tsunami

SUMA was deployed to the tsunami affected regions in Indonesia


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SUMA is also used by...

Major NGOs

• Red Cross

• MSF

• Caritas

The UN for

• UNDAC training

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2b. LSS


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Logistics Support System (LSS)

LSS is an agreement between UN agencies (WHO, WFP, OCHA, UNICEF, and UNHCR) to develop an integrated logistics system

It is part of a wider process to improve the overall coordination of UN agencies in emergencies

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Milestones of LSS

1. Agreement on the principles of humanitarian supply coordination between five UN agencies and key humanitarian NGO - 2004

2. Software design process

• β version developed - mid August 2004

• Verification of software - November-December 2004

• Field tested - July-December 2005

• First public version release - ?


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LSS Main Objectives

1. Facilitate the exchange of information among humanitarian institutions

2. Complement agency-specific commodity tracking systems

3. Minimize duplication and improve the response to actual needs of affected population

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LSS CORE FUNCTION


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3. Management of International Relief Teams

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Question

Should governments manage foreign relief agencies and workers entering their country after a disaster ?


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Management of International Relief Teams

Myth:

Foreign medical volunteers with any kind of medical background are needed

Reality:

The local population almost always covers immediate lifesaving needs. Only medical personnel with skills that are not available in the affected country may be needed

Source: PAHO (1999) Humanitarian Assistance in Disaster

Situations, A Guide for Effective Aid

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Types of international relief teams:

• government to government support – teams from Ministries and national agencies

• military support

• professional associations e.g. search and rescue

• NGO support

• spontaneous support – individuals arrive to “help”


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Issues of International Relief

• How to know who is offering support, who is on the way and who is already in the affected area?

• How to know the agency has the necessary expertise and team members are qualified and competent

• How to ensure accountability and transparency of foreign teams

• How to refuse unwanted offers of assistance

• How to ensure national policies and practices are respected e.g.DOTS, EPI

• How to deploy teams to where they are needed rather than where they want to go

• How integrate international teams into coordination mechanisms

• How to get international teams to submit reports before they leave

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Principles in the Management of International Relie f

• Foreign teams should only be sent in response to a specific request from the affected country

• Foreign agencies should register their presence and their staff with the national disaster agency and commit participate in national and local coordination processes

• Foreign teams should be asked to sign a code of conduct, to commit to be self sufficient and to not “poach” the best government staff


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Tools in the Management of International Relief

• The emergency / disaster laws of the country should define the roles and responsibilities of foreign teams and define mechanisms to initiate requests for foreign assistance

• Mechanisms and procedures are needed to accept, register and deploy foreign teams, ideally administered by and through the national disaster coordination agency

• Special arrangements may be needed to accept assistance from foreign military teams

• Mechanisms are needed to ensure that foreign teams know and respect local health practices: e.g. DOTS and EPI policy

• Mechanisms are needed to monitor the ethics and competenciesof foreign relief workers, and to address issues of malpractice and abuse

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Management of International Relief Teams …

The Ministry of Foreign Affairs is the lead government agency for managing foreign assistance, through providing:

• guidelines for foreign embassies on national policy and procedures for accepting foreign assistance (supplies and teams)

• standard protocols for embassies in foreign capitals to register agencies and qualifications of proposed team members wishing to travel to the disaster

• fast track process for National Disaster Coordinating Body to receive and clear applicationsto provide foreign assistance

• fast track process for visas, immigration and customs clearances


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• designated arrival points for foreign teams and supplies (they should never arrive directly at the disaster site)

• welcome desks at designated airports to receive, register, brief, issue ID cards, transport and accommodate foreign teams

• mechanisms to consult sectoral agencies and national disaster management agencies on pending offers to seek acceptance / refusal / delay / more information

• mechanisms to deploy foreign teams to places where they are actually needed and requested

• mechanisms to document the work of foreign teams

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Activity

• What are the constraints associated with managing international teams in emergencies?


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Why are there INTERNATIONAL RELIEF TEAM problems?

Pressure from the urgent situation and unrealistic demands/expectations of politicians, the media and the public lead to inappropriate operational decisions because of:

1. Lack of national policies and guidelines on foreign assistance in emergencies

2. Lack of national standards, procedures, protocols and criteria for selecting personnel needed to provide international relief assistance

3. Those who accept international offers (MOFA) and process them (Immigration) do not know what is actually needed


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4. Group Exercise


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Exercise Background

It’s 7 am on a Sunday morning in January. It is raining heavily andrain is expected to continue for the coming days.

At midnight, there was a severe earthquake to the north east of the Fiji islands – reports are that much of Vanua Levu is badly damaged. There is an assessment team from the military already on the island. They report that the airport and port at Savusavucan be used but repairs are needed and it will take 2 days to restore full capacity.

The government has declared a disaster, activated the national disaster response system and called for international assistance. Damage is light on Vitu Levu.

You are members of the logistics sub-committee of the NDMO, based in Suva. Your task is to set up a national supply management and logistics system for this emergency.

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Exercise

Mark on the map of the Fiji Islands :

1. The “red” and “yellow” and “green” zones around the disaster area, with access control points marked

2. The forward operations bases for local operations commanders and their logistics bases

3. The operational command base where:a. the overall commander is basedb. teams and supplies gather before being sent to the forward

operational bases4. The designated international arrival points for foreign teams5. The designated (air) ports for receiving foreign donations6. The chain of medical evacuation and the preferred routes7. The chain of communications8. The traffic flow and security control points

Task A - develop symbols and colour codes to represent each element

Task B - draw the flow of logistics on the map using symbols and lines


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Zoning

Red

Yellow

Green

Cold

Warm

Hot

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A B

C D

International donations at ports and

airportsForeign teams arrival point

National government

Local NGO, voluntary and commercial response Operations Command Base

The Logistics Flow Map

Injured, dead, evacuees, debris


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Zone A Zone B

Zone CZone D

HQ

HQ

HQ

HQ

HQ

HQ

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National committee

Overall commander

Zone commanders

Site commanders

Team leaders

The Operations Command Structure

A DCB

reporting


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Zone A Zone B

Zone CZone D

HQ

HQ

HQ

HQ

HQ

HQ

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Zone

warehouses

transport

communications

Hospitals

Temporary shelter areas

food

Care of the dead

water

Distribution points

Medical teams

SAR teams

warehouses

transport

communications

Relief teams

security

fuel

medicines

Registration

Lifelines teams

traffic control

staff rest and rotation

Airports / Ports Roads

Hospitals


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LOGISTICS AND SUPPLY SYSTEMS

THANK YOU

logistics and supply systems - world health organization phemap... · logistics and supply systems...

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